Only 5% of U.S. donations involve a transfer from a live donor, even though survival rates are better

Abhinav Humar, center, chief of transplant at UPMC, advocates for living donor liver transplants, which make up only about 5% of the liver transplants conducted in the U.S. PHOTO: UPMC

By Sumathi ReddyAug. 26, 2019 11:20 am ET

He is a 28-year-old police officer in North Carolina.

She is a 39-year-old child-care provider in West Virginia who stopped working because of a debilitating liver disease.

The two never met until the March day they were both discharged from a Pittsburgh hospital. Sarah Chambers had just received a liver transplant; the donor was from Zachary Lechette, who volunteered to give a portion of his liver to her, a complete stranger.

“I thanked him and told him he was always my angel and he would always be with me,” Ms. Chambers says. “He’s family now.”

Their story isn’t common, but represents what doctors hope will become a trend. Living liver donors account for only about 5%, or 400 of the roughly 7,500 liver transplants conducted annually in the U.S. Live kidney donor transplants are much more common in the U.S., with about 6,000 conducted a year. That surgery is less intense, with a shorter recovery time, doctors say.

Sarah Chambers sits in her home in West Virginia. Ms. Chambers received a liver transplant from a living donor in March, which she says has transformed her health. PHOTO: ROGER MAY FOR THE WALL STREET JOURNAL

In contrast, doctors say in many Asian countries the vast majority of liver transplants done are from living donors.

At hospitals like the University of Pittsburgh Medical Center, Cleveland Clinic and the University of California, San Francisco, doctors are pushing for more live donors and educating patients and their families about the option. The process removes 50% to 60% of the liver from donors. The organ regenerates back to its full size within a couple of months.

“We believe live donor transplants should be the first option offered to all patients,” says Abhinav Humar, chief of transplant at UPMC, who led the team that operated on Ms. Chambers and Mr. Lechette. “We work with them to help them try to find living donors. For most people, it’s hard, because it’s asking someone to undergo a major operation on your behalf. We teach them ways that they can approach family and how they can get someone to be an advocate for them, and use social media to reach out to a larger circle of people.”

Dr. Humar says live donors offer several advantages. Livers from deceased donors are allocated based on how sick a patient is. With some 13,000 people on the waiting list, many patients end up waiting a year or more.

As a result, about 15% to 25% of people on the waiting list end up dying from liver disease before qualifying for a transplant, Dr. Humar says.

In June, Ms. Chambers and her donor, Zachary Lechette, a police officer from North Carolina, bumped into each other at the Pittsburgh hospital where they were both having check-ups three months after their surgery. Here they are pictured with her parents, Janet and Roy Chambers. PHOTO: ZACHARY LECHETTE

Patients who get off the waiting list can be quite sick by the time they get a transplant, making them more vulnerable to complications from surgery, he says.

Dr. Humar published a study online in the Annals of Surgery earlier this month comparing 245 living donor liver transplants with 592 deceased donor transplants at UPMC. The researchers found that the three-year survival rates were greater for those who received a living donor: 86% versus 80%. Patients with a living donor also had shorter hospital stays, fewer blood transfusions and less post-transplant dialysis. They also found living donors had 30% lower overall costs.

At UPMC, living donor liver transplants now exceed deceased donor transplants. The hospital conducted 68 of the 401 living donor liver transplants in the U.S. last year, according to information from the United Network for Organ Sharing (UNOS), the nonprofit that runs the nation’s transplant system. There have been 293 such transplants in the country in the first seven months of 2019, according to UNOS.

Koji Hashimoto, director of the living donor liver transplantation and pediatric liver transplantation at Cleveland Clinic, says patients are often surprised to learn that they can get a transplant from a living donor.

Doctors say living donors must be between 18 and 55 years old and in good overall health. Though a matching blood type is ideal, there is a protocol for doing a transplant with a liver from someone with a different blood type.

The procedure can pose some dangers for liver donors—it is a major abdominal operation. Risks include blood loss, infection, wound complications, hernias and even death.

There have been about six liver donor deaths reported in the U.S. over 25 years, so the risk of mortality after a liver donation is 0.2% to 0.4%, Dr. Humar says. That’s more than the mortality risk for living kidney donors, which is about 0.03%.

Some doctors are more cautious about endorsing the practice of living liver donors.

Göran Klintmalm, emeritus chief of the transplant institute at Baylor University Medical Center in Dallas, says though he supports living donor donations, he has some ethical worries.

“We have to ask ourselves, what kind of risk can we subject a healthy human being to?” he says. “I don’t think we can be too cautious. We have to make sure that the donors are aware of the risks, and that the recipients are aware of the risks.”

Most donors stay in the hospital for five to six days. Those with desk jobs generally need four weeks to go back to work, while those with more physically demanding jobs may need to take off eight to 10 weeks to fully recover.

Mr. Lechette first got the idea of donating an organ when a co-worker had a sick child who needed a kidney transplant and died. That motivated him to donate his left kidney to a stranger he later met in 2015.

“I always had it in the back of mind that I wanted to do it again,” he says.

Mr. Lechette and his wife, Caitlin Lechette, in May, after he donated his liver. Mr. Lechette, who donated 60% of his liver, was in the hospital for a week and out of work for nine to 10 weeks recovering. He says he feels back to his normal self now. PHOTO: ZACHARY LECHETTE

He saw a TV commercial for UPMC’s living liver donation program last year and reached out to begin the evaluation process.

Ms. Chambers had been diagnosed with nonalcoholic fatty liver disease in 2014. She stopped working three years ago and was in and out of the hospital every month. She couldn’t go grocery shopping without having to sit down and rest.

“I would just stay in bed all day sometimes,” she says.

Her parents were too old to donate. And a cousin looked into donating but got pregnant.

The transplant was life-changing. She started feeling better within a month of the surgery. “Now you can’t keep me still,” she says. “I walk 2 to 3 miles every day. I feel like a new woman.”

She hopes to return to work after her six-month checkup.

Ms. Chambers says she cried and hugged Mr. Lechette when they met.

“He’ll never know what he’s done for me and my family,” she says. “We lost my brother suddenly at the age of 40, and I was sick on top of that, and he just gave my family peace.”

Mr. Lechette donated 60% of his liver. He was out of work for nine to 10 weeks. (He used accrued sick leave.) He is back at work and feeling fine now, with his liver back to its normal size.

He met Ms. Chambers and her parents at the hospital and they coincidentally met again in June at their three-month checkups.

“Just putting a face and a name with the act of donating was very rewarding,” Mr. Lechette says, “and knowing that she’s already feeling better and gaining more and more strength every day. She had been waiting for a while and this was the break that she and her family said they were waiting for.”